Physiotherapy in Mesothelioma Treatment

Mesothelioma is a rare, aggressive form of cancer that develops from the thin layer of tissue covering different internal organs. The most common lining affected is the outer lining of the lungs and chest wall. Other areas commonly affected are the lining of the abdominal cavity, the sac surrounding the heart and the sac surrounding the testis.

Exposure to asbestos is the major cause of mesothelioma. So, people who have worked with or been exposed to asbestos are at the highest risk. Symptoms of mesothelioma can take 20-50 years to appear in this population. Mesothelioma has no known cure yet and thus the life expectancy for mesothelioma patients is poor. Many factors like the stage and level of spread of disease, affected area, patient’s age, and general health condition impact the prognosis and patients’ survival.

Signs and symptoms of mesothelioma

• Shortness of breath due to fluid around the lung (pleural effusion)
• Trouble breathing or chest pain
• Effusion in the abdomen
• Anemia (especially in women)
• Loss of weight
• Fatigue
• Wheezing, hoarseness, cough
• Blood in the sputum (hemoptysis)
• Nausea/vomiting

Four Stages of Mesothelioma:

1. The mesothelioma tumor is localized and has not spread to other parts of the body
2. The tumor is seen or spread to nearby local tissues or the lymph nodes but has not spread any further
3. The tumor has spread beyond local tissue to surrounding locations and lymph nodes
4. The tumors have spread into multiple areas and throughout the lymphatic system and other organs throughout the body

Mesothelioma Treatment

Mesothelioma treatment protocol is similar to other types of cancer. Typically, the three most used line of treatments are surgery, chemotherapy, and radiation therapy.  In common, stage 1 and stage 2 mesothelioma responds to surgery and other forms of therapy. Stage 3 and stage 4 are often treated palliatively.

Physiotherapy in Mesothelioma Treatment

The signs and symptoms of mesothelioma and the side effects of primary treatments of mesothelioma can severely debilitate the patients’ quality of life. Physiotherapy can not help eradicate cancer or prevent recurrence but is important to reduce the side effects of primary cancer treatments like fatigue, immobility, malaise, pain, weakness, depression etc. some common forms of physical therapy interventions are cardiovascular training, scar management, fatigue management, and strength and endurance training. Thus, physiotherapy is the necessary part of mesothelioma treatment to improve survivor’s quality of life and overall health.

A recent study of Clague J. and Berstein L., (2012), have detailed the importance of physical activity post-diagnosis of mesothelioma and reported the reduction of mortality in cancer patients as well as recurrence of the disease. Study on the functional results after lung-sparring radical pleurectomy in the management of malignant pleural mesothelioma by Bolukbas S., et al. (2012), have considered the positive effect of physical therapy on the improvement of the patients. Similarly, Wood H., et al (2013), have concluded that the physiotherapy interventions like breathing control or exercises, activity management, are beneficial in the management of breathlessness for the patients with intrathoracic malignancy.

How physiotherapy can help

Fatigue management

Fatigue is the major issue for most cancer patients. This fatigue can not be alleviated by getting adequate rest or sleep. Although it seems counterintuitive, a number of studies have recommended physical activity as the best approach to fighting fatigue for cancer patients. Patients should be screened using the NCCN (National Comprehensive Cancer Network) Fatigue Practice Guidelines before beginning the program. These guidelines can be accessed from the NCCN Web site http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive – NCCN

Respiratory therapy

Chest physiotherapy including breathing exercises and airway clearance techniques can help alleviate patient from breathing difficulty, coughing, and thoracic mobility.

Cardiopulmonary rehabilitation

A well designed cardiopulmonary rehabilitation program can reduce serious life-threatening complications following surgery and immobility. It improves patients’ endurance level and thus encourages patients in physical activities. The cardiopulmonary rehabilitation program has also been cited to help improve the psychological well-being of the patients.

Increase mobility

Being physically active is a big challenge for mesothelioma patients due to fatigue and pain. A well designed cardiopulmonary training program including aerobic exercises, stretches, strength training and other therapies can help patients to improve overall physical fitness, alleviate pain, improve mood and therefore improve the quality of life.

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